Qualify for the state health exchange? It’s time to enroll

Nov. 17--If you do or can get your health insurance through Covered California -- and about 19,000 of you in Kern County currently do -- don't worry about last week's election.

Just enroll.

That's the message from Peter Lee, executive director of the state health insurance exchange, which is in the middle of open enrollment.

Yes, President-elect Donald Trump wants to repeal and replace the Affordable Care Act, which resulted in the Covered California exchange. But change never happens in Washington, D.C., overnight -- including any overhaul of Obamacare, Lee said.

"We at Covered California and those insured should live in the here and now," he told The Californian. "We're open for business, the law is on the books, and people who have subsidies will have them through 2017."

What does change on a dime? Getting diagnosed with cancer or getting into a car accident, Lee said. And that's why you need health insurance, he said.

Enrollment is open through Dec. 15 for coverage that starts Jan. 1. If people are confused about their options, and Lee said many people are, they can get help on Covered California's website, http://www.coveredca.com.

"If people are confused, take a deep breath, go online and find someone in the community to answer your questions," Lee said.

And getting help is free, he said.

Lee also stressed that signing up for healthcare coverage through Covered California is not signing up for "government care." In Kern County, he said, it's getting coverage from companies like Anthem, Blue Shield, Health Net and Kaiser Permanente, "the best private plans anywhere."

Lee said he's not worried people will eschew coverage because they think Obamacare is going away. He's worried, as he's been from Day One of the exchange, that people will decide it's cheaper to pay a penalty than to pay for health insurance.

Lee calls it "crazy math" because paying the penalty means paying to get nothing.

Steve Schilling, CEO of health clinic chain Clinica Sierra Vista, said he's hearing a lot of concern among patients about what will happen to their coverage, whether it's through Covered California or the expansion of Medi-Cal. Clinica is one of the state's top enrollers in the programs.

Schilling is pretty confident nothing will happen to people's coverage in 2017, saying his read of things is that when people sign up and pay for insurance, whether with a private company or the federal government, they're entering into a binding contract for the term of it.

Beyond that, who knows what changes to the nation's healthcare system Trump and the Republican-controlled Congress are going to want to make, Schilling said.

On the Medicaid side, he said, they could block grant funding to the states, which he's seen tried four times. If that happens, Schilling said, then we'll have to see what coverage options California would offer through state version Medi-Cal and the extent to which it could and would provide subsidies.

Schilling is even less certain about what Trump intends to do about the system under which people get insurance through exchanges like Covered California.

He said Trump seems to like some provisions, such as requiring insurance companies to cover people with pre-existing conditions and allowing children stay on their parents' plans into their mid-20s. Trump seems to dislike the government mandate that people buy, and employers provide, insurance.

Problem is, Schilling said, costs will skyrocket without insurance mandates that bring money into the system. Premiums are going up now, he said, in part because the current individual and employer mandates are too "wimpy."

"As long as we keep people out of the risk pool, or allow them to leave the risk pool, the pool gets more expensive," Schilling said.

Trump is going to learn that there are other important parts of the program that ought to be maintained, he said, such as filling gaps in coverage for seniors and requiring that insurers spend 85 percent of their money on patient care.

But you can't change one piece of the puzzle without impacting a whole lot of other pieces, so it will probably take a year or more to sort out, Schilling predicted.

How it will play out has huge ramifications for the country, he said, and to him it all looks up in the air.

"There are a ton of extremely confusing and mixed messages coming out of Manhattan and Washington," he said. "I have no idea what's going to happen on Jan. 20."